Prior Approval Limits |
Prior Approval Limits
SR 1000 |
Prior Approval Limits
SR 500 |
Room & Board in the appointed medical Network Provider is 100% |
Room & Board in the appointed medical Network Provider is 100%
Regular Suite |
Room & Board in the appointed medical Network Provider is 100%
Single Room |
Room & Board in the appointed medical Network Provider is 100%
Shared Room |
Room & Board outside the network of providers (in/out KSA): |
Room & Board outside the network of providers (in/out KSA):
Per Day SR 1000 |
Room & Board outside the network of providers (in/out KSA):
Per Day SR 800 |
Room & Board outside the network of providers (in/out KSA):
Per Day SR 600 |
Annual Limit (Sum Insured) Per Person Per Year (PPPY) including sublimits mentioned in the Policy
(*Small and medium enterprises are supported through Insurance Daman program for expenses exceeding 500 thousand). |
Annual Limit (Sum Insured) Per Person Per Year (PPPY) including sublimits mentioned in the Policy
(*Small and medium enterprises are supported through Insurance Daman program for expenses exceeding 500 thousand).
SR 1,000,000* |
Reimbursement Benefit: Reimbursement of claims is applied for emergency and non-emergency cases Outside and Inside KSA on Reasonable & Customary basis for the same eligible ART networks. |
Reimbursement Benefit: Reimbursement of claims is applied for emergency and non-emergency cases Outside and Inside KSA on Reasonable & Customary basis for the same eligible ART networks.
Covered Emergency & Non-Emergency |
Reimbursement Benefit: Reimbursement of claims is applied for emergency and non-emergency cases Outside and Inside KSA on Reasonable & Customary basis for the same eligible ART networks.
Covered Emergency |
Territorial Scope: Extended to Worldwide in emergency cases only while on Business trips, Vacation and Holidays for upto 60 days in the aggregate. |
Territorial Scope: Extended to Worldwide in emergency cases only while on Business trips, Vacation and Holidays for upto 60 days in the aggregate.
KSA |
Chronic & Pre-existing Conditions up to Policy Limit PPPY |
Chronic & Pre-existing Conditions up to Policy Limit PPPY
Covered |
In-Patient Companion (for children below 12 years) Or when the case medically required subject to the treating physician |
In-Patient Companion (for children below 12 years) Or when the case medically required subject to the treating physician
Covered |
Pregnancy/Delivery Benefit: (Normal Delivery, Ante Natal Care, Caesarian Section & Abortion) |
Pregnancy/Delivery Benefit: (Normal Delivery, Ante Natal Care, Caesarian Section & Abortion)
SR 25,000 |
Pregnancy/Delivery Benefit: (Normal Delivery, Ante Natal Care, Caesarian Section & Abortion)
SR 20,000 |
Pregnancy/Delivery Benefit: (Normal Delivery, Ante Natal Care, Caesarian Section & Abortion)
SR 15,000 |
Delivery complication: |
Delivery complication:
Covered |
Pre term newly born babies coverage is up to policy annual limit from day one of the policy |
Pre term newly born babies coverage is up to policy annual limit from day one of the policy
Covered |
Co-insurance /Deductible: The Insured/Patient will pay The Percentage mentioned as co-insurance against each and every Outpatient Claim. |
In-Patient & Emergency Treatments |
In-Patient & Emergency Treatments
NIL |
Minimum network of Hospitals and Clinics (MPN) |
Minimum network of Hospitals and Clinics (MPN)
20% up to SR 75 |
Clinics, Medical Centers, Labs, Pharmacies outside minimum network (OCN) |
Clinics, Medical Centers, Labs, Pharmacies outside minimum network (OCN)
20% up to SR 100 |
Hospitals outside minimum network (OHN) |
Hospitals outside minimum network (OHN)
20% up to SR 300 |
Generic, Over-the-counter drugs (OCT) and innovative treatment - with no generic alternative |
Generic, Over-the-counter drugs (OCT) and innovative treatment - with no generic alternative
20% up to SR 30 |
Innovative treatment - with a generic alternative |
Innovative treatment - with a generic alternative
50% (No Max Cap) |
Consultation fees in the appointed Network providers. |
Consultation fees in the appointed Network providers.
Covered |
Vaccinations for Children as specified by MOH up to (6) years of age |
Vaccinations for Children as specified by MOH up to (6) years of age
Covered |
Dental Benefit
1200 SAR with NIL Deductible for Essential & Preventive Dentistry.
800 SAR with 20% Deductible with No Max Cap for Treatments of Root Canals and Emergencies |
Dental Benefit
1200 SAR with NIL Deductible for Essential & Preventive Dentistry.
800 SAR with 20% Deductible with No Max Cap for Treatments of Root Canals and Emergencies
SR 3,000 |
Dental Benefit
1200 SAR with NIL Deductible for Essential & Preventive Dentistry.
800 SAR with 20% Deductible with No Max Cap for Treatments of Root Canals and Emergencies
SR 2,500 |
Dental Benefit
1200 SAR with NIL Deductible for Essential & Preventive Dentistry.
800 SAR with 20% Deductible with No Max Cap for Treatments of Root Canals and Emergencies
SR 2,000 |
Optical: Frames & Medical Lenses up to PPPY
(Only for those aged 14 years and less) |
Optical: Frames & Medical Lenses up to PPPY
(Only for those aged 14 years and less)
SR 1,500 |
Optical: Frames & Medical Lenses up to PPPY
(Only for those aged 14 years and less)
SR 1,000 |
Optical: Frames & Medical Lenses up to PPPY
(Only for those aged 14 years and less)
SR 400 |
Renal Dialysis |
Renal Dialysis
SR 180,000 |
Kidney Transplant |
Kidney Transplant
SR 250,000 |
Hearing Aids |
Hearing Aids
SR 6,000 |
Ambulance: within the city limits / Borders |
Ambulance: within the city limits / Borders
Covered |
Repatriation of bodily remains to Home Country |
Repatriation of bodily remains to Home Country
SR 10,000 |
Physiotherapy |
Physiotherapy
Covered |
Physician Charges Limits inside the network |
General Physician |
General Physician
Covered |
Specialist I (Registrar ) |
Specialist I (Registrar )
Covered |
Specialist I I(Senior Registrar) |
Specialist I I(Senior Registrar)
Covered |
Consultant |
Consultant
Covered |
Rare specialties such as the heart and vascular surgery, brain , nerves and subspecialties standards by the Saudi Commission for Health Specialties |
Rare specialties such as the heart and vascular surgery, brain , nerves and subspecialties standards by the Saudi Commission for Health Specialties
Covered |
Physician Charges Limits outside the network |
General Physician |
General Physician
SR 50 |
Specialist I (Registrar ) |
Specialist I (Registrar )
SR 200 |
Specialist I I(Senior Registrar) |
Specialist I I(Senior Registrar)
SR 100 |
Consultant |
Consultant
SR 300 |
Rare specialties such as the heart and vascular surgery, brain , nerves and subspecialties standards by the Saudi Commission for Health Specialties |
Rare specialties such as the heart and vascular surgery, brain , nerves and subspecialties standards by the Saudi Commission for Health Specialties
SR 500 |
CS / NVD '' IVF PREGNANCIES" Delivery Limit |
CS / NVD '' IVF PREGNANCIES" Delivery Limit
Covered |
Cost of Transplanting Organs " Donor" |
Cost of Transplanting Organs " Donor"
SR 50,000 |
Alzheimer's Cases |
Alzheimer's Cases
SR 15,000 |
The cost of the national program to reduce disability for newborns to reduce disability |
The cost of the national program to reduce disability for newborns to reduce disability
SR 100,000 |
Disability Cases |
Disability Cases
SR 100,000 |
Obesity Operation |
Obesity Operation
SR 15,000
(with 20% Copayment up to Max 1000/SR) |
Contraception (Hormonal Contraceptives Therapy and Intrauterine Devices) |
Contraception (Hormonal Contraceptives Therapy and Intrauterine Devices)
SR 1,500 |
Circumcision for newly born boys |
Circumcision for newly born boys
SR 500 |
Ear piercing for newly born girls |
Ear piercing for newly born girls
SR 300 |
Table of immunization of the Respiratory syncytial virus (RSV) approved by the Ministry of Health |
Table of immunization of the Respiratory syncytial virus (RSV) approved by the Ministry of Health
Covered |
Coverage of the early screening program for hearing impairment and the program of congenital heart defects for all births. |
Coverage of the early screening program for hearing impairment and the program of congenital heart defects for all births.
Covered |
Covering the operations of treating obesity through the process of quantifying the stomach only (Sleeve) in the case of BMI 45 (BMI) |
Covering the operations of treating obesity through the process of quantifying the stomach only (Sleeve) in the case of BMI 45 (BMI)
SR 20,000 |
Autism Cases |
Autism Cases
SR 50,000 |
Milk formula for infants up to 24 months of age, when medically necessary and as per the Internationally recognized indications. |
Milk formula for infants up to 24 months of age, when medically necessary and as per the Internationally recognized indications.
Covered |
Cover the costs of psoriasis treatment |
Cover the costs of psoriasis treatment
Covered |
Psychological disorders |
Psychological disorders
SR 50,000 |
Cover non-acute conditions with limit of (SR 5000) for 4 sessions with medicine |
Cover non-acute conditions with limit of (SR 5000) for 4 sessions with medicine
SR 15,000 |
Cost Of Cardiac Valves Failure |
Cost Of Cardiac Valves Failure
SR 150,000 |
Coverage of newborns on the mother's card up to a maximum of 30 days from the date of birth until they are added in the policy retroactively from the date of birth. |
Coverage of newborns on the mother's card up to a maximum of 30 days from the date of birth until they are added in the policy retroactively from the date of birth.
Covered |
Adult Vaccination as per MOH
(including Tdap, PCV13, PPSV23 and influenza vaccine) |
Adult Vaccination as per MOH
(including Tdap, PCV13, PPSV23 and influenza vaccine)
Covered |
Sexually Transmitted Diseases (STDs) |
Sexually Transmitted Diseases (STDs)
Covered |
Periodic examinations / Screenings |
Periodic examinations / Screenings
Covered |
Menopausal and Perimenopausal Health Care |
Menopausal and Perimenopausal Health Care
Covered |
Telemedicine |
Telemedicine
Covered |